5 pieces of advice nobody tells you before starting residency

Since medical school, I’ve gone through an additional 6 years of training, read countless volumes of medical literature, and had the fortune of having some great teachers. Through it all, experience has been the greatest teacher, which I suppose is what training is about. I’ve watched with interest as advice has been hashed out on the web around this time of year to new trainees on all matter of subjects. And much of it is good and useful, to be sure.

Being the helpful person that I am, I naturally want to do my part. What, I thought, could I contribute to this discussion that hasn’t been said already?

To that end I’ve come up with my own list of of trivial and only slightly helpful tidbits of information, based on my own experiences over the last 11 years post graduation. Here I give you my top 5 list of things that no one ever told me in medical training, but should have.

1. Before conducting a family meeting, go the restroom. Scan your face for things that might appear distracting or unseemly, like nasal boogies or lettuce stuck in your teeth, and quickly remove them. If you are one of the few convertible drivers with hair, pay special attention to this area; the “mad scientist” look is generally not one which inspires confidence in these situations.

2. Using hospital Jello-O and graham crackers as the base of your food pyramid makes for a reasonably strong pyramid. At least as strong as any other pyramid that has a soft mushy substance at its base.

3. Sometimes an appropriately discharged patient will refuse to leave the hospital. Follow your hospital’s policy in these situations. If it is your hospital’s policy to call security, then do so. However it would be wise to have your patient fill out the house officer rating/feedback form before doing so.

4. If your attending physician gives you an answer that seems wishy-washy, it’s because they don’t know the answer. They still know a heck of a lot more than you, though.

5. When entering a room to declare death on a patient, whose family is in the room, make sure your pager is on vibrate. Particularly remember to silence any cutesy ring tones (such as Katy Perry or the Benny Hill theme) that might bring unwanted awkwardness to an otherwise somber moment.

Deep Ramachandran is a pulmonary and critical care physician who blogs at CaduceusBlog.